ABSTRACT
Although Bruton treated the first agammaglobulinemic patient with subcutaneous injections of immune serum globulin1, the intramuscular regimen used by Janeway, Gitlin and their colleagues in Boston soon became the standard of care2,3. In the late 1970s, Berger and colleagues introduced the use of small, battery-powered syringe driver pumps to administer, slowly, larger amounts of immune serum globulin than would be tolerated by intramuscular injection4,5. Shortly after that, however, the first preparations of immunoglobulin G (IgG) for intravenous use were licensed in the USA and became the predominant form of IgG replacement used in this country. Interest in subcutaneous infusions continued in Europe, nevertheless, particularly in the Scandanavian countries, and a number of protocols for both slow and rapid subcutaneous infusion were developed. Several studies, including large series, have shown the safety, practicality and advantages of the subcutaneous route of IgG replacement6-8. Stiehm and associates reported that patients who had severe adverse reactions to multiple intravenous immunoglobulin (IVIG) preparations could tolerate IVIG when it was given by slow subcutaneous infusion9. Despite these reports, there is no preparation of IgG licensed for subcutaneous administration in the USA.
